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Frequently Asked Questions about Billing and Insurance

Q: How do I know if my Avera facility contracts with my insurance company?

A: To receive full insurance benefits, some health plans require you to go to an "in-network" or "participating provider" doctor or hospital. Please call your insurance company to make sure of its conditions. Be sure your Avera hospital or doctor is in its network.

Q:  If my Avera facility is "out-of-network," can I still go there?

A: In an emergency situation, go to the nearest hospital. Your insurance company may either cover these costs or ask that you go to an "in-network" hospital if it is safe to do so.  If you choose to go to an "out-of-network" hospital in a non-emergency, you may have to pay a larger deductible or a greater part of your bill. Be sure to know the "out-of-network" rules of your insurance plan.

Q: How do I know if my insurance company will cover my hospital bill?

A: Coverage varies with each insurance company. Some insurance plans require you to call for approval before you receive certain services, or to tell the plan within a certain time after you are hospitalized. Be sure you know your insurance company's coverage requirements. On elective procedures, always ask both your physician's office and your insurance plan about coverage. Please discuss your concerns about insurance or payment with the admissions staff when you register, or with business office or billing staff as soon as possible.

Q: How will I know how much I owe?

A: Your insurance company will send you an "explanation of benefits" that shows:

  • Information about what is paid
  • Any non-covered, deductible or denied amounts
  • The balance owed by you

Look over this notice carefully. Call your insurance company or the number on your hospital bill as soon as possible with concerns. The hospital will also send you a bill for any remaining balance due (non-covered charges and co-payments, co-insurance or deductibles you did not pay at registration or discharge from the hospital).

Q: How much will Medicare or Medicaid pay?

A: Medicare and Medicaid generally will pay for a majority of hospital services. You will be responsible for deductibles and co-payment. If you belong to a Medicare or Medicaid managed care plan, you may need an authorization to see a physician or receive hospital services.

Q: Why do I have to give you information about other insurance if I have Medicare?

A: Before we bill Medicare, Medicare requires us to bill any insurance that could be responsible for your expenses. Medicare does not allow us to file claims until the other insurance company denies them. In some cases, another party may be responsible for your expenses before we bill Medicare. For example, if you were hurt in a car accident, at work or on someone else's property, the hospital must make sure those claims are filed correctly. This is why we need to have complete information about all of your insurance.

In a spirit of charity and justice, Avera exists in response to God's calling for a healing ministry to the sick, the elderly and the oppressed, and to provide health care services to all persons in need without regard to race, sex, creed, national origin or ability to pay.